Narcotic medications can be essential for managing severe pain, but they also can cause quite serious constipation that is difficult to control with everyday remedies or laxatives. Sometimes the constipation is so intractable that the person must abandon use of the pain medication.
A Medicine to Control Constipation Due to Pain Medication:
In 2014, the FDA approved a prescription pill that will be able to counteract the opioid effects of drugs like oxycodone on the large bowel without affecting pain relief elsewhere in the body. Naloxegol is sold under the brand name Movantik.
An article published in The New England Journal of Medicine reported that the drug was helpful in overcoming narcotic-induced constipation. In two clinical trials naloxegol was helpful over 40 percent of the time compared to placebo which helped about 30 percent.
This problem has been extremely difficult for many people with chronic pain who have had to choose between adequate pain relief and being able to evacuate. The previous treatment that FDA approved for opioid-induced constipation was an injection, possibly more appropriate for hospitalized patients. So from The People’s Pharmacy perspective, it could be quite helpful to have a pill to counteract the constipation.
Not all patients agree. Here is what some have said.
Kathy wondered:
“I’m not seeing any major positive changes from Movantik, and have taken it about 6 weeks.
“Still have some issues with opiate constipation, and find I have to push harder to “go” than prior to using this med.
“I’m wondering if you can skip a day of it, just to see if things are better off without it..?”
Jackie reported:
“This drug has the ability to send you into withdrawal immediately and with severe symptoms, much more than one would normally have from just quitting the opioid. I have tried it three times, and the instant withdrwal is steep and painful. Not worth it. While it seems nothing works…even three Amitiza or Linzess…this drug causes deep pain and frozen chills that last for days.”
Theresa had this tale of woe and intrigue:
“I have been diagnosed with IBS since 2001, but with constipation. I know there is another term for the constipation side of IBS. In 2003 I was started on opiate pain meds for several other painful issues. Because I have never used the bathroom regularly, since a teenager, I didn’t put much thought into the narcotics making me worse. When asked if I was still normal, I would say yes, because I was evacuating normally for me. Now, fast forward and 11 years of opiate pain management, I also needed surgery for an umbilical hernia with mesh placement and had severe difficulty evacuating after surgery…constipation and also not being able to use ab muscles. I was prescribed linzess. After about 3-4 days I had severe diarrhea, all water, and didn’t dare pass gas without being close to a restroom. Then I noted that my pain meds didn’t seem to be working well. Constant watery diarrhea, and less pain control.
“Then something strange happened. For work I am drug tested, as usual I take my scripts with me, to show the nurse that I am prescribed, I gave my urine sample, she tested it, I began to pull my scripts out of my purse, she said no need to see them I passed with no trace of narcotic. Impossible I said, taking up to 5 oxycodone 10mg tabs daily there was no way I didn’t have it in my urine. Spoke to my pcp who chalked it up to faulty test, or because it was a dip test (test strips). Didn’t think much more about It, until now.
“February 2016, stricter laws from the FDA, meant I had to go on a pain management contract, subject to med counts and urine testing. First week of July 2016, I gave my urine sample, it was sent off to the lab. My results came back as barely a trace of oxycodone in my system. (Remember I’m still taking linzess, watery diarrhea). Decreased pain management. I have discovered that only taking the linzess 2-3 times a week has made me pretty normal that way. However, I got a call from my pcp’s office, because I only had a very small trace of opiate in my urine and my pcp has completely dropped me off of my pain meds saying that since nothing was in my system I’m not taking them. WHAT? I take them every day, with explosive, water diarrhea, and I am positive the oxycodone evacuates as well. Remember I don’t have good pain control now. My test was at the exact time I was figuring this out. I backed off the linzess and my pain management has come back around.
“Now I see my pcp tomorrow as per my every 30 days for scripts, however this time it’s to tell me he will not give me a script that I will never get another one again. So my story, be careful what you take, with constipation from opiate pain management. I’m concerned about the sudden withdrawal my doctor is forcing me into, but more so of the pain I will be in constantly and the withdrawal from my family because of pain. Not to mention the health risks I am facing from the sudden stop after 13 years. I have the rest of today’s and tomorrow’s doses of oxycodone left and then sudden stop!”
Non-Drug Approaches to Overcoming Constipation:
Q. I take tramadol to help me manage pain. I frequently have to add naproxen or ibuprofen to ease the arthritis in my hips and knees.
I have been having trouble with constipation and suspect that the tramadol is contributing. Do you have any recommendations for dealing with this besides laxatives?
A. Constipation can be a complication of many medications, including tramadol, naproxen and other powerful pain relievers. It is also triggered by some antidepressants, blood pressure pills and drugs for osteoporosis.
Since changing medications could be challenging, you may want to try some alternate approaches such as magnesium supplements, sugarless gum or candy, vitamin C, papaya extract or high-fiber foods such as flaxseed or hummus.
We are sending you our Guides to Digestive Disorders and Constipation with ten tips to combat constipation and recipes for pumpkin-bran muffins and Power Pudding, a mixture of bran, prune juice and applesauce.
Revised 9/13/18
